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Nurses' experiences of restructuring in three Ontario hospitals.

PURPOSE: To describe the effects of restructuring, particularly redeployment, on nurses' personal and work lives, and to compare the utility of "survivor syndrome" and empowerment as alternative concepts for understanding these effects and planning change. METHODS: Twenty-six focus groups or interviews were held with 59 nurses working in three hospitals in Ontario, Canada. FINDINGS: Participants described how restructuring strategies had affected them as individuals, as members of nursing teams, and as employees. In each of these aspects of their work lives, relationships became less integrated, their work activities became less controllable, and the changes compromised their ability to deliver effective care. CONCLUSIONS: Restructuring intensifies structural weaknesses in professions, such as nursing, whose members are primarily employed by bureaucracies. Nurses may not find survivor syndrome a useful model to explain their low morale following restructuring because it identifies nurses as "patients" in need of therapy. An empowerment model that takes into account nurses' concerns about uncertainty and integration may be more fruitful for devising strategies to enhance their ability to practice effectively in hospital settings.

Adaptation, Psychological↗

Patient-focused work redesign: hospital and pharmacy department restructuring.

Patient-focused care is a new way of doing business in hospitals. Work redesign initiatives can be an opportunity or a threat to established pharmacy structures. Seizing the opportunity, pharmacy departments can use redesign efforts to implement pharmaceutical care. Key features of a redesign initiative include vision development, objective setting, and defined operating strategy elements. This article describes the process used in a patient-focused care initiative at MultiCare Medical Center and its Department of Pharmacy Services, Tacoma, Washington.

Hospital Restructuring↗

Assessing, developing, and maintaining staff's competency in times of restructuring.

Downsizing and reorganization in hospitals have resulted in nursing staff being realigned to different areas. During these times, nurse educators are continually challenged to provide effective educational programs to develop and upgrade staff competency. Nurse educators at a government health care facility in New York City experienced similar challenges as inpatient units were closed and staff had to develop or upgrade their skills. Two educational programs were designed to prepare staff to assume other duties, and competency assessments were developed and used to measure the effectiveness of the programs. Concepts relevant to competency assessment, development, and maintenance are discussed, and methods of assessments are described. Sample assessment tools and description of outcomes are included.

Clinical Competence↗

Initiating a patient service partner program.

Rising costs and the need to increase patient satisfaction are driving hospitals to restructure care delivery. At one hospital, housekeeping, food service and nurse technician duties are combined to form one nurse-extender role: the Patient Service Partner (PSP). Findings about patient and nurse satisfaction before and after implementation show that nurses agreed that the PSP program improved patient care delivery and helped control costs. Patients reported the same or higher rating of satisfaction with various aspects of their hospitalization. Call lights were answered more quickly and attitudes of personnel answering the lights were more positive. Nurses are finding more time for patient education and documentation.

Cost Control↗

1992 Mary J. Nielubowicz Award recipient. Nursing organizational restructure: choosing to change.

Major organizational change frequently results in fear, anxiety, and resistance. Change is often initiated in response to a perceived threat. However, intentional changes to historical patterns of nursing care delivery are now more prevalent, in the absence of crisis, as leaders anticipate new challenges and fulfill today's nurses' need for high-level professional satisfaction. This essay describes factors which inspired nursing organizational restructure at a naval hospital. The specific modifications made and strategies for managing them are reviewed in the context of using planned change principles and risk-taking behavior to achieve organizational growth.

Awards and Prizes↗

Does the birth of DRGs mean the death of corporate restructuring?

To many, the birth of DRGs on the federal level announced the death of corporate restructuring. However, the author believes that the DRG system reinforces the credibility of corporate restructuring and substantially enhances its importance. In this article, he reviews the different areas in which restructuring can help hospitals to better position themselves in a changing health care delivery system.

Costs and Cost Analysis↗